title: Discontinuing anticoagulation following successful atrial fibrillation ablation in patients with prior strokes.
abstract: OBJECTIVE
  This study was conducted to examine the outcomes in patients with prior stroke/transient ischemic attack (CVA/TIA) after atrial fibrillation (AF) ablation and the feasibility of discontinuing oral anticoagulation (OAC).
  
  
  METHODS
  This study examined long-term outcomes following AF ablations in 108 patients with a history of prior thromboembolic CVA/TIA. Because of risks of OAC, we frequently discontinue OAC in these patients after successful ablation. These patients understand the risks/benefits of discontinuing OAC and remain on OAC for a longer time following successful AF ablation, compared to our patients without prior CVA/TIA.
  
  
  RESULTS
  Patient age was 66.2 ± 9.0 years with an average CHADS2 score = 3.0 ± 0.9 and CHA2DS2-VASc score = 4.1 ± 1.4. Following 1.24 ablations, 71 (65.7%) patients were AF free 2.8 ± 1.6 (median 2.3) years after their last ablation. OAC was discontinued in 55/71 (77.5%) patients an average of 7.3 months following the final ablation. These 55 patients had 2.2 ± 1.3 (median 1.8) years of follow-up off of OAC. Kaplan-Meier analysis suggests little AF recurrence >1 year following initial or final ablations, suggesting that 1 year post successful ablation may be the appropriate time to consider discontinuing OAC. Thirty-seven patients had AF postablation, and 32/37 (86.5%) remained on OAC. One patient with a mechanical valve had a stroke despite OAC. Bleeding occurred in 8.3% of patients on OAC and 0% of patients off OAC (P = 0.027).
  
  
  CONCLUSIONS
  Patients with prior CVA/TIAs, who undergo successful AF ablation, have a low incidence of subsequent thromboembolic events. Most patients who appear AF free postablation may be able to discontinue OAC after successful ablation with a low thromboembolic risk and with a reduced bleeding risk.
authors.affiliation: Silicon Valley Cardiology, 1950 University Avenue, Suite 160, East Palo Alto, CA, 94303, USA, rawinkle@aol.com.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Winkle
authors.forename: R Hardwin
authors.initials: RH
authors.lastname: Mead
authors.forename: Gregory
authors.initials: G
authors.lastname: Engel
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Kong
authors.forename: Rob A
authors.initials: RA
authors.lastname: Patrawala
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000401:mortality; D015897:Comorbidity; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000401:mortality* / Q000517:prevention & control*; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000517:prevention & control*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants